Assessing the delivery of comprehensive care at a dental school.

A key mission of a dental school is to train students to be competent dentists through the delivery of comprehensive care to patients. Comprehensive care is defined as a seamless and integrated dental treatment that addresses all patients' dental needs. Identification of a health care problem is the essential first step in quality improvement to medical education curriculum and its outcomes. It is critical for students to receive adequate clinical experience and for patients to receive needed treatment. This study assessed the degree to which comprehensive care was delivered from the patient and student perspective, and to determine why patients discontinue their course of treatment. We conducted a retrospective analysis of electronic health record (EHR) data in one group practice at the University of Texas School of Dentistry at Houston. Semistructured interviews of patients, students and faculty were also conducted. The results showed that 29% of assessed and admitted patients received comprehensive care. A large proportion of dropouts occurred after the third or fourth visit. It took on average 9.8 visits and 210 days for patients to complete their planned treatments. Dental students had a patient family of 25-29 patients, delivered 75% of their care in their fourth year, and predominantly provided restorative treatments compared with other dental disciplines. Interview transcripts were analyzed to determine strengths, weaknesses, and opportunities relating to the provision of comprehensive care. Patients perceived that they received cost effective and high quality care. Students and faculty provided suggestions for streamlining care. Findings from both the retrospective analysis of EHR data and semi-structured interviews revealed several areas for improvement. One solution that was subsequently piloted was to combine the separate assessment and treatment planning appointments into a single all-day session to reduce patient dropouts. During the pilot period over the summer session, 84 patients were scheduled in the combined assessment and treatment planning session. Of this population, 69% percent were accepted and deemed suitable for undergraduate care. And 83% among those accepted received a treatment plan on the first appointment. In the future we expect to integrate more formal evidence-based exercises and reassess the impact of these changes in improving educational and clinical care outcomes. In addition we expect to adopt evidence-based solutions and reassess the impact of these changes in improving educational and clinical care outcomes.